Director, TPA Operations

Join VEBA Direct, a groundbreaking DMHC-approved pilot program in California, as the Director of TPA Operations. This role is your opportunity to lead, scale, and professionalize the operational oversight of our Third Party Administrator (TPA) relationship. You’ll ensure our innovative employer-direct model operates efficiently, compliantly, and better than traditional health plans.

In this role, you’ll take full ownership of TPA operations, driving vendor performance, compliance, and operational excellence. You’ll lead new client implementations, manage complex projects, and ensure seamless transitions into steady-state operations. By optimizing processes and enabling scalability, you’ll position VEBA Direct for growth and success. You’ll also act as a trusted partner to internal teams, provider medical groups, and external stakeholders, ensuring alignment and collaboration.

Key Responsibilities

TPA & Delegated Vendor Oversight

• Own the day‑to‑day operational relationship with the Third‑Party Administrator, ensuring performance meets contractual obligations, service levels, and regulatory requirements.
• Provide oversight of all subcontracted and delegated functions performed by the TPA, including performance monitoring, issue escalation, root cause analysis, and continuous improvement.
• Ensure ongoing compliance with DMHC requirements and delegated model standards.
• Maintain audit readiness and lead operational support for regulatory reviews, audits, and inquiries.
• Hold vendors accountable through data‑driven performance management and documented remediation plans.

Implementation & Project Leadership

• Lead all new client implementations, expansions, and operational changes across the VEBA Direct book of business.
• Serve as the operational owner for implementation planning and execution, including:
• • Master project plans and timelines
  • Data migration and system integrations
  • Testing, validation, and readiness assessments
  • Regulatory and contractual compliance checkpoints
  • Risk identification, mitigation, and issue management
• Partner with internal teams, the TPA, and external stakeholders to establish realistic milestones and Go‑Live dates, ensuring delivery against commitments.
• Ensure seamless transition of accounts from implementation into steady‑state operations.

Operational Excellence & Scalability

• Monitor and analyze operational performance metrics to identify opportunities for increased efficiency, accuracy, and scalability.
• Lead process optimization and technology enablement initiatives to support growth, new products, and evolving regulatory requirements.
• Identify system enhancements and workflow improvements across delegated operational functions.

Client, Provider & Stakeholder Engagement

• Act as a highly visible internal and external operational leader and trusted partner to the TPA, provider medical groups, and internal teams.
• Serve as the primary operational contact for PMG onboarding in partnership with the Network Manager.
• Lead internal and external project meetings; develop agendas, document decisions, and track action items to completion.
• Advise internal stakeholders and vendor partners on operational best practices, system capabilities, staffing models, and workflow design.

Documentation, Training & Governance

• Develop and maintain comprehensive operational and project documentation, including:
• • Project plans and status reporting
  • Risk and issue logs
  • Communication and change management plans
  • Integration and technology documentation
  • Go‑Live materials and acceptance deliverables
• Create executive‑ready reports, presentations, process flows, program manuals, and training materials.
• Plan and facilitate training sessions for internal teams, clients, and vendor partners (virtual and onsite as needed).
• Support the development, implementation, and enforcement of operational policies and procedures in alignment with leadership direction.

Here’s what you’ll bring to the role:

• 10+ years of experience in health plan operations, with expertise in delegated models and TPA oversight.
• Hands-on knowledge of claims, eligibility, provider management, and other core operational functions.
• Proven ability to lead complex implementations in regulated environments.
• Strong skills in contract interpretation, vendor accountability, and stakeholder management.
• A bachelor’s degree (required); a master’s degree (MBA, MPH, or related field) is preferred.
• A proactive, organized, and collaborative approach to problem-solving and execution.

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We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. 

Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve:

• Medical/dental/vision plans, which start from day one!
• Life and accident insurance
• 401(K) and Roth options
• Tax-advantaged accounts (HSA, FSA)
• Educational expense reimbursement
• Paid parental leave

Other benefits include:

• Digital mental health services (Talkspace)
• Flexible work hours (availability varies by office and job function)
• Training programs
• Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
• Charitable matching gift program
• And more...

**The benefits summary above applies to fulltime positions. If you are not applying for a fulltime position, details about benefits will be provided during the selection process.

We value inclusion and diversity

Click Hereto review our U.S. Eligibility Requirements

Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work.

Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest.

Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws.

Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.